'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

No increased risk of death with benzodiazepine use, study finds

Benzodiazepine use is not associated with increased risk of death, according to a recent study.

Patients starting benzodiazepines for the first time were not found to be at increased risk of death compared to patients who visited a doctor in the same time frame but did not start benzodiazepines.

The large observational study, published in the BMJ, looked at health records for just under 1.7m US patients who started benzodiazepines and just over 1.9m patients who did not start the drugs but did have a medical visit during the study period.

It found that 8,945 deaths occurred in the benzodiazepine-using group, compared to 5,347 in the non-using group. The researchers, from the Harvard Medical School, found that benzodiazepine users - who typically suffered from anxiety, sleep disorders or mood disorders - were at a 79% increased of death compared to non-users.

However, this fell dramatically when adjusted for confounding factors, finding that there was in fact an 11% reduced risk of death compared with non-users. The researchers also found that there was no increased risk of death in those aged over 65, who were more frequently prescribed the drugs.

They noted a small increased risk when comparing benzodiazepine users to SSRI users, but pointed out that the reduction in risk with adjusting the figures means that any increase is likely due to residual confounding.

The paper said: ‘If a detrimental effect on all-cause mortality exists, it is likely to be much lower than previously stated and to have only modest clinical relevance, given its magnitude from both an absolute and a relative perspective.’

In the UK, NICE guidance says patients with an anxiety disorder should not be prescribed benzodiazepines 'unless specifically indicated'. It says this is because they 'are associated with tolerance and dependence'.

For insomnia, a short course of temazepam, loprazolam or lormetazepam should be considered 'only if daytime impairment is severe', according to NICE.